Place the patient supine on the operating table (see Fig. 1-1). Dorsomedial approaches and medial approaches are carried out with the leg in its natural position of slight external rotation. Exsanguinate the leg, then apply a tourniquet to the mid-thigh.

Palpate the first metatarsal cuneiform joint by feeling along the medial border of the foot from distal to proximal. The first metatarsal flares slightly at its base to meet the first cuneiform. Continue moving proximally along the medial border to reach the tubercle of the navicular. The medial side of the talar head is immediately proximal to the navicular. It can be located by inverting and everting the forefoot. The motion that occurs between the talus and the navicular is palpable.

Make a 5- to 6-cm longitudinal incision directly over the area to be exposed (Fig. 28-1).